Transitions of Care & Care Coordination Flashcards
7 cards from real MTM practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Transitions of Care & Care Coordination flashcards as text
Which communication channel is MOST effective for transmitting a medication reconciliation summary to a primary care physician after a patient is discharged from a skilled nursing facility?
Answer: A written, structured medication list faxed or sent via secure EHR message
A written structured summary sent through a secure channel creates a permanent record, reduces transcription errors, and ensures the receiving provider has the information before the follow-up visit.
An MTM pharmacist identifies that a patient's discharge instructions list metformin 1000 mg twice daily, but hospital records show the dose was reduced to 500 mg twice daily due to acute kidney injury. This is an example of:
Answer: A medication reconciliation discrepancy — unintentional dose change
An unintentional dose discrepancy between actual hospital orders and discharge paperwork is a classic medication reconciliation error that can lead to patient harm if not corrected.
Which of the following BEST describes the pharmacist's role in an interdisciplinary care transitions team?
Answer: Providing medication expertise, identifying drug therapy problems, and communicating with the care team to ensure safe handoffs
Pharmacists contribute clinical medication expertise to the interdisciplinary team, identifying and resolving drug therapy problems while facilitating communication to ensure medication safety across the continuum of care.
A patient with chronic kidney disease is discharged on NSAIDs prescribed by the hospitalist. The MTM pharmacist identifies this as a drug therapy problem. The MOST appropriate next step is to:
Answer: Contact the prescriber with a recommendation to use an alternative analgesic appropriate for renal function
NSAIDs can worsen renal function in CKD; the pharmacist should proactively communicate the concern and suggest a safer analgesic alternative, functioning within the collaborative scope of MTM practice.
Under Medicare Part D MTM programs, which care transition scenario MOST directly triggers an enhanced eligibility for a Comprehensive Medication Review (CMR)?
Answer: A patient recently hospitalized and newly diagnosed with a qualifying chronic condition
CMS encourages MTM outreach after hospitalizations and new chronic disease diagnoses because medication regimens change significantly, increasing the risk of drug therapy problems.
Which of the following is a validated measure used to assess care transition quality in MTM programs?
Answer: The Care Transitions Measure (CTM-3)
The Care Transitions Measure (CTM-3) is a validated patient-reported tool that assesses preparation and self-management support during care transitions, directly relevant to MTM program quality.
A patient is transferred from an acute care hospital to a long-term care facility. The nursing home's medication administration record lists a different antihypertensive than the discharge summary. The pharmacist's action should be to:
Answer: Clarify the discrepancy with the prescriber before administering either medication
Any discrepancy must be clarified with the prescriber to determine which medication is intended, preventing a potential medication error from an unresolved transition-related discrepancy.